Spindle cell carcinoma of the breast: a case series of a rare histological subtype

Aim: Spindle cell carcinoma (SpCC) represents <0.5% of breast cancers. We report the 15-year experience of SpCC at the Nottingham Breast Unit. Methods: Histopathology and case notes of metaplastic carcinomas with predominant spindle cell differentiation were analysed for patient demographics, tumour pathology, c-erb B-2 oestrogen (ER) and progesterone (PR) receptor status and radiology. Treatment, recurrence and survival rates were also analysed. Results: Nineteen patients with SpCC were identified. The median age was 68 years (range 27–92). Large ill-defined mass was the only consistent radiological features suggesting SpCC. Mean tumour size was 53 mm, (range 16–200 mm). Fifteen tumours were grade 3 and four were grade 2. Six out of 15 patients with axillary surgery had positive lymph nodes (40%). All tumours were oestrogen (ER) and progesterone (PR) negative. One tumour was focally c-erb B-2 positive in the non-spindle cell component. Median Nottingham Prognostic Index was 5.2 (range 3.6–6.6). Primary treatment was surgical in 89%. Adjuvant chemotherapy was given in four cases. The median disease free interval was 7 (range 2–109) months. Twelve cases recurred (63.2%). The main sites of metastasis were the lungs (9 cases), bone (6) and liver (1). Eleven cases have died of breast cancer (58%). Median survival was 18 months (range 4–109). Conclusion: SpCC is an aggressive histological type of carcinoma of the breast. Omitting node sampling may result in significant under-staging. Negative ER, PR and c-erb B-2 status limits treatment options.